Healthcare Provider Details

I. General information

NPI: 1124265822
Provider Name (Legal Business Name): SOURABH KHARAIT M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N CAMPBELL AVE
TUCSON AZ
85719-4330
US

IV. Provider business mailing address

1625 N CAMPBELL AVE DEPT OF MEDICINE, COLLEGE OF MEDICINE
TUCSON AZ
85719-4330
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-6371
  • Fax: 520-626-2024
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA107133
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number334100
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number80182
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: